COB Specialist, Payment Integrity

Oscar Health•Remote, AZ

1d•$64,832 - $85,092•Remote

About The Position

Oscar is hiring a COB Specialist to join their Payment Integrity team. This role supports Coordination of Benefits (COB) efforts for Payment Integrity, investigating and verifying proper payment of Oscar medical and pharmacy claims. The specialist will create new COB workflows, enhance existing ones, and drive COB audits. The position reports to the Manager, Payment Integrity.

Requirements

A bachelor's degree or 4+ years of commensurate experience
4+ years of experience in payment integrity, ideally coordination of benefits
Experience with coordination of benefits reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
2+ years experience deriving business insights from datasets and solving problems
1+ years experience improving business workflows and processes
1+ years experience collaborating with internal and/or external stakeholders

Nice To Haves

2+ years of experience working with large data sets using excel or a database language, preferably SQL.
Experience with pharmacy coordination of benefits
Experience in a professional healthcare claims organization
Knowledge management, training, or content development in operational settings

Responsibilities

Contribute as a subject matter expert for Oscars COB reimbursement policies
Respond to internal and external inquiries and disputes regarding COB policies
Use knowledge gained through research and claims review to ideate COB opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver COB solutions.
Use insights from partner submissions, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve COB problems.
Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
Analyze, investigate and confirm if dual coverage exists for Oscar membership
Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
Compliance with all applicable laws and regulations
Other duties as assigned